[Charleston, WV] West Virginia's opioid crisis, already responsible for the highest incidents of drug-related deaths in the nation, could be further exacerbated under the House plan to repeal the Affordable Care Act (ACA). According to new estimates released today by the Center on Budget and Policy Priorities, the House ACA repeal would cut West Virginia's Medicaid funding by more than $5 billion over the next ten years, jeopardizing the Mountain State's ability to provide adequate coverage for substance use disorder (SUD) treatment to all eligible residents. Read the report, Building on the ACA's Success Would Help Millions with Substance Use Disorders.

Despite the AHCA's failure to even reach the House floor for a vote, Republicans are reportedly continuing negotiations to try and revive it or may pursue ways to severely cut and cap funding for the Medicaid program – a move that could disproportionately affect millions of people for SUD treatment.

The ACA's expansion of Medicaid to low-income adults have allowed million of people with SUDs to get health coverage and access to SUD treatment services, according to a comprehensive report last year from the U.S. Surgeon General. In addition, because the ACA deemed it an essential health benefits, millions of people bought coverage in the individual and small-group markets, including those getting coverage through the health reform's marketplace, have also gained coverage for SUD treatment.

"With the highest rate of drug-related deaths in the country, the last thing West Virginia needs it to reduce access to life-saving treatment," said Ted Boettner, Executive Director of the West Virginia Center on Budget and Policy. "But the House Republican health bill would do just that."

The House Republicans' ACA repeal bill, the American Health Care Act, would have threatened the gains in coverage for SUD by effectively ending the Medicaid expansion and capping and cutting Medicaid funding, in addition to other provisions that would have weakened individual and small-group market coverage and affordability. The bill would have left 24 million more people uninsured and shifted hundred of millions of costs to states, including those that have been hit disproportionately by the opioid epidemic.

"Rather than cutting access to SUD treatment, policymakers in Washington and here in the state should take steps to build on the success of the ACA to increase insurance eligibility and coverage for people with SUD," Chantal Fields, Executive Director of West Virginians for Affordable Health Care said. "West Virginia has made tremendous strides under the ACA and its Medicaid expansion. We need to build on that success, not go backward."

These steps include:

Maintaining Medicaid's current financing structure. As currently structured, Medicaid expands to meet need, which ensures that states receive federal support to meet increasing demand for health care services, including public health challenges such as opioid addiction. Radically restructuring Medicaid's financing system by converting it to a per capita cap, as House Republicans proposed, would eliminate Medicaid's automatic response to need, and shift costs to cash-strapped West Virginia, likely forcing the state to cut services, reduce eligibility, and stop testing new models of treatment or recovery supports.

Rejecting state medicaid proposals that would restrict eligibility or benefits for people with SUDs. Requirements such as drug testing beneficiaries, instituting work requirements, or requiring excessive cost-sharing would be particularly harmful for people who need SUD treatment. People need to keep their coverage regardless of their drug use, ability to pay, or job status. Working is difficult for people enrolled in a treatment program, and drug testing Medicaid beneficiaries is likely to deter people from seeking coverage and keep them from getting the treatment they need.

Keeping the essential health benefit requirements for plans in the individual and small-group markets to ensure that substance use treatment is covered. Before the 2008 Mental Health Parity and Addition Equity Act (MHPAEA) and the ACA, health plans routinely did not include substance use treatment or tightly constrained what they covered and for how long, so enrollees rarely used the benefits. The ACA went a step further, requiring all health plans in the individual and small-group markets to provide a package of minimum federal standards, known as "essential health benefits" (EHBs), for the services that health plans must cover including SUD services.